Ashley Rae Gallina, APRN, CNM, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Fox Lake, IL
NPI 1619667656 · NPPES record last updated Jun 22, 2026
Key facts
- NPI
- 1619667656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.031083 (IL)
- Practice address
- 7227 State Park Rd
Fox Lake, IL 60020-1027 - Phone
- (815) 363-2020
- Fax
- (949) 703-8263
- NPI assigned
- May 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
214 Washington St
Ingleside, IL 60041-9208
Phone (815) 529-4014
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250317000193 | IL | Practitioner - Nurse Practitioner | 5991227282 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.031083 | IL | MD | Family Nurse Practitioner |
| 209024423 | IL | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakes Health and Wellness LLC | Family | Current |
Accepting new patients |
Locations
7227 State Park Rd
Fox Lake, IL 60020
214 Washington St
Ingleside, IL 60041
Phone (815) 477-8900
214 Washington St
Ste 1
Ingleside, IL 60041
Phone (847) 584-3004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 209024423 | IL | |
| Family Nurse Practitioner | 363LF0000X | 209.031083 | IL | Yes |
Addresses
Primary practice location
7227 State Park Rd
Fox Lake, IL 60020-1027
Mailing address
7227 State Park Rd
Fox Lake, IL 60020-1027
Phone (815) 363-2020
Other practice location 1
214 Washington St Ste 1
Ingleside, IL 60041-9208
Phone (815) 363-2020
Other providers in Fox Lake, IL
- Dynamic Hand Therapy & Rehabilitation Limited Partnership
- Dynamic Hand Therapy & Rehabilitation Limited Partnership
- Everspring Counseling PLLC
- Alex James Ferenc
- Fox Lake Fire Protection District
- Altijana Gallup
- Mrugendra M. Gandhi
- Eva Angelica Garcia
- Grant Community High School District 124
- Lizbeth Guzman
All providers in Fox Lake, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.